Insomnia: Treatments, Symptoms, Causes, and More

• Insomnia is a sleep disorder that results in difficulty falling and staying asleep.
• Insomnia can happen due to stress, medications, medical conditions, genetics, and more.
• The main forms of treatment for insomnia include cognitive behavioral therapy (CBT) and medications. Lifestyle changes can also help.

Never underestimate the power of a good night’s sleep. When you don’t get enough sleep, it can lead to sleep deprivation, which can negatively affect your overall health.

Insomnia (also called ​“sleep-onset insomnia”) is a sleep disorder that makes it hard to fall asleep and stay asleep, or causes you to wake up regularly in the middle of the night.

Types of Insomnia

There are two types of insomnia:

• Short-term insomnia: lasts from a few days to a few weeks and is often triggered by a temporary stressful event.
• Long-term (chronic) insomnia: lasts for at least three months.

Insomnia is common, affecting at least 30% of people in the U.S., with 5–15% experiencing chronic insomnia.

Symptoms of insomnia may include:

• Difficulty falling asleep
• Daytime fatigue or exhaustion that may cause sleepiness
• Waking in the middle of the night
• Mood changes, such as feeling irritable, cranky, or depressed
• Having trouble concentrating or remembering things
• Difficulty doing work or tasks, making errors regularly, etc.
• Slowed or delayed reactions

Insomnia can happen for multiple reasons. In some cases, it may be a standalone issue; in other cases, it may be related to another medical condition.

Causes of insomnia typically include:

• Stress
• Poor sleep habits, including eating heavy meals, consuming caffeine, or drinking alcohol before bed
• Shift work or travel (particularly frequent travel that includes changing time zones) 
• Certain medical conditions, including chronic pain, diabetes, cancer, asthma, Parkinson’s disease, and heart disease
• Certain medications, including anti-depressants, blood pressure or asthma medications, or medications that contain caffeine or other stimulants
• Mental health disorders, including anxiety or post-traumatic stress disorder (PTSD)
• Other sleep disorders, like sleep apnea or restless legs syndrome
• Genetics
• Hormone changes, due to pregnancy, menopause, or otherwise

Risk Factors

Insomnia can happen to anyone, but those with a higher risk of developing insomnia include:

• Women
• Older adults (over 60)
• Those with physical or mental disorders
• Those under a significant amount of stress
• Those without a regular sleep schedule

To diagnose insomnia, a healthcare provider will typically perform the following:

1. Physical exam: During the exam, your provider will ask about your symptoms, family history, and medical history. 
2. Tests: Blood tests may be administered to help rule out causes related to poor sleep.
3. Sleep habit review: Your provider will discuss your current sleep routine and habits to better understand your sleep schedule. This typically includes a questionnaire that shows your sleep-wake cycle and daytime sleepiness. You may also be asked to keep a sleep diary to document your sleep patterns.
4. Sleep study (if necessary): If there still isn’t a clear cause for your insomnia, your provider may order a sleep study, notably if you’re experiencing symptoms related to another sleep disorder. These studies typically take place overnight at a sleep center and measure factors such as body movements, heart rate, breathing, brain waves, and eye movements.
5. Additional testing (if necessary): Other tests that may be administered to rule out other sleep disorders include multiple sleep latency tests, actigraphy, and sleep apnea tests.

You may be diagnosed with chronic insomnia if you meet the following criteria:

• Experience insomnia symptoms at least 3 times per week
• Symptoms must have occurred for at least 3 months
• There aren’t temporary explanations for your sleep disruption, such as work changes
• Your symptoms can’t be explained due to other medical conditions, substance use disorders, or medications.

To decide how best to treat insomnia, it’s important to determine its cause. If temporary stressors, poor sleep habits, medications, or underlying health conditions cause your insomnia, resolving these root issues will likely alleviate your sleep issues. 

However, if the cause of your insomnia is unknown, chronic, or worsening, cognitive behavioral therapy and medications may be considered.

Cognitive Behavioral Therapy for Insomnia (CBT‑I)

Cognitive behavioral therapy (or cognitive behavioral treatment) is a form of talk therapy (or psychotherapy) that involves working with a mental health professional in a structured, goal-oriented way to address and overcome thinking patterns that are causing issues. Cognitive behavioral therapy for insomnia usually consists of six to eight sessions with a healthcare professional who specializes in behavioral sleep medicine. These sessions can be conducted in person, by telephone, or online, and focus on changing negative thought patterns and behaviors that contribute to or prolong insomnia. Once identified, strategies are created to help manage the issues.

Some strategies that may be implemented during CBT‑I include:

• Sleep restriction therapy: A type of therapy that involves limiting the amount of time spent in bed to the average amount of hours of sleep needed.
• Sleep hygiene: This involves finding ways to improve your sleep, such as avoiding caffeine before bedtime and creating a relaxing sleep environment.
• Relaxation techniques: This involves incorporating yoga, meditation, journaling, and/​or breathing exercises into your daily routine to mitigate stress.
• Stimulus control therapy: A type of therapy that involves associating the bed/​bedroom with sleep and nothing else. This typically means only using the bed for sleep and going to bed when sleepy, while avoiding other activities such as watching TV or eating in bed.
• Cognitive therapy: A type of therapy that focuses on addressing negative thoughts, behaviors, beliefs, or emotions that contribute to insomnia.
• Light therapy: A type of therapy that addresses circadian rhythm issues by using artificial light that mimics sunlight to help a person adjust their body clock and sleep better. While not a core component of CBT‑I, it’s often used as an add-on treatment.

For help finding a CBT‑I therapist, check out:

• CBTI‑I International Directory
• BetterHelp
• Psychology Today Search 

Medications

CBT‑I is typically the first-line treatment for insomnia, but in some cases, medication may also be recommended if you’re still having trouble sleeping.

Your provider may prescribe medications to help you achieve deep sleep. Over-the-counter sleep aids can help with sleep, but they shouldn’t be taken without talking to your healthcare provider first.

Prescription Medications

Prescription medications, such as ​“z‑drugs” or melatonin receptor agonists, can help you fall asleep, stay asleep, or both. These medications aren’t meant to be relied on, but many are safe for longer-term use as needed. These medications may also interact with other medicines you’re taking, and may result in other side effects, so you and your healthcare provider should discuss the pros, cons, and risks of these medications.

Examples of prescription medications that help you fall asleep include:

• Benzodiazepine medications: Central nervous system depressants that slow down brain activity, including Triazolam, Zaleplon, Zolpidem tartrate, Eszopiclone, and Temazepam
• Melatonin Receptor Agonists: a prescription hypnotic used to treat insomnia, such as Ramelteon.

Examples of prescription medications that help you stay asleep include:

• Benzodiazepine medications: Central nervous system depressants that slow down brain activity, including Temazepam and Zolpidem tartrate.
• Dual Orexin Receptor Agonists (DORA): Central nervous system depressants, hypnotics, and sedatives that block orexin neuropeptides to keep you from waking at night, such as Suvorexant orexin.
• Tricyclic Antidepressants: Antidepressants that treat insomnia by blocking histamine receptors in the brain. Examples include Doxepin hydrochloride.
• “Z‑Drugs”: Sedative-hypnotic medications that slow down the nervous system. Examples include Eszopiclone.

Sleep Aids

Over-the-counter medications and sleep aids may also help you achieve restful sleep because they contain antihistamines. However, these medications aren’t meant to be taken long-term, and you should consult your healthcare provider before taking them.

Other options, like herbal or dietary supplements, may also be beneficial. However, because the Food and Drug Administration does not require manufacturers to prove safety or efficacy (that they work), it’s best to exercise caution before taking them. Even more, some people experience side effects that worsen their insomnia, like dry mouth and rebound daytime drowsiness (“the hangover effect”), and headaches.

Examples of common sleep aids or sleeping pills include:

• Diphenhydramine
• Doxylamine
• Melatonin supplements
• Valerian
• Magnesium 
• Tart cherry juice/​supplement

Tip: Try drinking a ​“Sleepy Girl Mocktail” made with cherry juice, magnesium powder, and seltzer water before bed.

Improving your sleep routine and learning good sleep habits can make a big difference in obtaining deep rest and potentially falling asleep faster.

Here are 7 tips for how to improve your sleep:

• Stick to a regular sleep schedule: On average, 7–8 hours of sleep is recommended for a full night’s sleep. Going to bed and getting up at the same time each day can help you maintain a consistent circadian rhythm, allowing you to sleep better.
• Limit naps: Taking too many naps or naps that run too long may affect sleep at night. If you must take a nap, limit it to 15–45 minutes and take it earlier in the day.
• Incorporate relaxation techniques: Implementing stress-relieving practices, such as yoga, meditation, and progressive muscle relaxation, into your daily routine can help you sleep more peacefully at night.
• Create a restful environment: Maintaining a moderate, comfortable temperature, limiting the amount of light and noise while sleeping, and only using the bedroom for sleep and sex can help you feel more relaxed.
• Stay physically active: The Centers for Disease Control and Prevention (CDC) recommends getting 150 minutes of moderate physical activity per week, and it can help you feel more rested at night. 
• Avoid caffeine and alcohol at night: Caffeine and alcohol can cause sleep problems, especially when consumed close to bed. 
• Don’t eat heavy meals before bed: Eating heavy meals close to bedtime can negatively affect your sleep. Strive to eat your last full meal 3 hours before bedtime, and avoid spicy or overly filling foods.